Mem Inst Oswaldo Cruz, Rio de Janeiro, VOLUME 116 | 2021
Perspective

Should COVID-19 be branded to Viral Thrombotic Fever? [ACCEPTED ARTICLES / PRELIMINARY VERSION]

Costa-Filho, RC1, +; Castro-Faria-Neto, HC2; Mengel, J3; Pelajo-Machado, M4; Martins, MA5; Leite, ET6; Mendonça-Filho, HTF7; Brasil de Souza,TAC8; Bentacor, GB9 ;Leite Gagliardi, JP10

1Hospital Pró Cardíaco – Founder and coordinator of Department of Critical Care - Americas Medical Services - UHG (UnitedHealth Group) Brasil
2Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, FIOCRUZ -RJ
3Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz, FIOCRUZ -RJ and Faculdade de Medicina de Petrópolis, UNIFASE, Petrópolis, Rio de Janeiro
4Laboratório de Patologia Instituto Oswaldo Cruz (IOC/ FIOCRUZ) Rio de Janeiro (RJ), Brasil
5Laboratório de Inflamação, Instituto Oswaldo Cruz, FIOCRUZ
6Instituto Nacional do Câncer (INCA) - Rio de Janeiro
7Políticas de Saúde – UHG (UnitedHealth Group) Brasil
8Fundação Oswaldo Cruz-Fiocruz, Instituto Carlos Chagas, Laboratório de Proteômica Estrutural e Computacional, Curitiba, PR, Brasil
9Laboratório de AIDS & Imunologia Molecular, Instituto Oswaldo Cruz, FIOCRUZ
10Laboratorio de Virologia Comparada e Ambiental, FIOCRUZ

DOI: 10.1590/0074-02760200552
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ABSTRACT

Coronaviruses can cause a diverse array of clinical manifestations, from fever with symptoms of the common cold to highly lethal Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). SARS-CoV-2, the coronavirus discovered in Hubei province, China, at the end of 2019, became known worldwide for causing COVID-19. Over one time-period, the scientific community has produced a large bulk of knowledge about this disease and countless reports about its immune-pathological aspects. This knowledge, including data obtained in postmortem studies, points unequivocally to a hypercoagulability state. However, the name COVID-19 tells us very little about the true meaning of the disease. Our proposal is more comprehensive; it intends to frame COVID-19 in more clinical terminology, making an analogy to Viral Hemorrhagic Fever (VHF). Thus, we found irrefutable evidence in the current literature that COVID-19 is the first viral disease that can be branded as a Viral Thrombotic Fever. This manuscript points out that SARSCoV-2 goes far beyond pneumonia or SARS. COVID-19 infections promote remarkable interactions among the endothelium, coagulation, and immune response, building up a background capable of promoting a “thrombotic storm,” much more than a “cytokine storm.” The importance of a viral protease called main protease (Mpro) is highlighted as a key component for SARS-CoV-2 replication in the host cell. A deeper analysis of this protease and its importance on the coagulation system is also discussed for the first time, mainly because of its similarity with the thrombin and factor Xa molecules, as recently pointed out by structural comparison of crystallographic structures.

ORCID https://orcid.org/0000-0002-9725-3762
+ Corresponding author: rubens1956@gmail.com
Received 21 October 2020
Accepted 01 April 2021

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